NATURE’S PROZAC: WHAT ST JOHN’S WORT CAN DO FOR YOU

Some people call them joy pills. To others, they are nature’s Prozac. In Australia, they’re on the shelf in bottles labelled St John’s wort.

St John’s wort (wort means plant) has been used as a medicine for thousands of years and is now gaining popularity as an antidepressant. In Germany, which is known as the world’s herbal heartland, it is reported that more than 60 million doses of this herbal extract are prescribed every year for conditions such as moderate depression, fear and nervous disturbances.

Now the esteemed British Medical Journal has published a German study showing that St John’s wort (hypericum) is effective enough to be considered as a first-line treatment for mild to moderate depression.

The study showed that in moderately depressed people not only was this herbal extract as effective as mainstream tricyclic antidepressant medication, but it also had advantages in the way it could be tolerated by patients, and in their willingness to con-tinue taking it.

While this study found hypericum to be safe and to improve quality of life, the trial was limited to 8 weeks. The questions that now arise are whether the extract is effective and safe in the long term and appropriate for more severe forms of depression.

From an Australian point of view, it would have been more useful if these researchers had compared the extract with the modern antidepressants known as selective serotonin re-uptake inhibitors, or SSRIs. They did the comparison with the popular tricyclic, imipramine, because it is the most frequently prescribed antidepressant in primary care in Germany.

Commenting on the study, an editorial in the journal confirmed the research had provided further evidence for the effectiveness of St John’s wort, but said its place in antidepressant treatment was not yet fully established.

Such British caution contrasts strongly with the enthusiasm for the extract found on the Internet. One site, which offers joy pills for sale, claims that St John’s wort is a clinically proven all-natural mood elevator and stabiliser and is for anyone who wants to ‘decrease anxiety, gain greater mental clarity, get a good night’s sleep, enhance self-esteem, feel good (but not high), reduce guilt… create a level emotional playing field – on which to build a good life.’

But these pills shouldn’t be bought over the Internet because not all providers are entirely reliable and the consistency of preparations varies.

When the LA Times newspaper did a spot check of retail St John’s wort supplements available in Los Angeles, its independent laboratory tests found a marked range in the potency of different brands. Furthermore, of the 10 brands sampled, none of the laboratory results matched the claims made on the label about potency.

In Australia, this is less of a problem. All herbal preparations sold over the counter have to comply with basic standards set by the Therapeutic Goods Administration. Their producers have to have Good Manufacturing Practice licences, and any therapeutic claims have to be verified and approved.

Herbal preparations that have been listed in the Australian Register of Therapeutic Goods all carry an ‘AUST L’ number on their labels. Preparations with an ‘AUST L’ number are inherently low risk in nature. If this number is missing, the preparation has bypassed the authorities, and there is a fair chance it was personally imported or bought off the Internet.

Hypericum is available as an oil, tea, tincture, tablet, pill or capsule. The dose used in the German journal study was very large, at 350 mg of hypericum three times daily, in capsule form.

What is needed now is not another clinical study on raw extracts of hypericum but work that will isolate and characterise the active substances (or substance) and determine their likely pharmacological site and mechanism of action and their metabolic fate.

This had been done with numerous other useful medicines of plant derivation, from opiates to salicylates, and was the way of achieving better therapeutic agents.

In the past few years, there has been growing interest in St John’s wort. Two books about its effects on depression have recently been published. One suggests this herb could change the way depression is treated in America. The other is a how-to book about using it as an antidepressant.

Not everyone can take St John’s wort. There have been warnings against its use by children, in pregnancy, by breastfeeding mothers, by people with high blood pressure and by those taking other medication such as antidepressants, oral contraceptives and anticonvulsants. Its side effects include stomach upsets and, in rare cases, sensitivity to light.

Some of the more extravagant claims made in the name of hypericum include assertions that it has antiviral, anticarcino-genic, anti-inflammatory and antibacterial properties. Like many herbs named after saints, it is said to have spiritual effects.

If any of this is remotely true, St John’s wort may become the wonder drug of the new century. Move over aspirin!

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